scholarly journals Experiences with an intra-articular pain catheter in approx. 3.000 TKR over a period of 6.5 years

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Burkhard Mai
Keyword(s):  
Muscle Power ◽  
Pain Treatment ◽  
Femoral Nerve ◽  
Case Series ◽  
Pain Reduction ◽  
Quadriceps Muscle ◽  
Turnover Time ◽  
Soft Tissue Coverage ◽  
Autonomous Mobility ◽  
Pain Catheter

The optimal pain treatment after a TKR has been under discussion for a long time. With the use of pain catheters you can save analgesics and opiates. A femoral and sciatic nerve catheter became already established. Disadvantages are a the time-consuming application of the catheter with neuro-tracer or ultrasound as well as facing possible palsy, especially of the extension muscle of the knee, which disturbs the autonomous mobility of the patients. Would it be possible to treat the postoperative pain sufficiently and preserve the active mobility of the patients by using an intraarticular pain catheter, that will not influence the muscle power, which can also be used time-sparing during TKR surgeries in combination with an external, continuous local anesthesia from a portable valve-controlled reservoir? We report on case series of our clinic from July 2010 till October 2017, which included more than 3.000 TKRs. We made use of 4 different catheter and pump systems (for example the Painbuster). The LA used was Ropivacaine. With a postoperative rate of fluid flow of 10-15 ml/h in a concentration of 3,75 mg/ml (0,375%) Ropivacaine Hydrochloride over a period of 2-3 days, we achieved a good pain reduction comparable to a femoral catheter and perfusor application of 2,0 mg/ml (0,2%) Ropivacaine. Most patients feel strong pain following a TKR due to the special vulnerability of the knee joints with large inner surface of the joint and thin soft-tissue coverage. The established pain catheters positioned beside the femoral nerve need a relative long turnover time (the time from the end of the previous surgical procedure to the beginning of the next) and have an important disadvantage of palsy of the quadriceps muscle with the risk of falling due to the immobilization of the patient. The intra-articular painbuster systems lead to excellent pain reduction and fast mobilization of the patient with full control of muscle power. The application of the catheter during the operation is not time consuming and you will not face longer turnover and surgery times.

scholarly journals Changes in Maximal Isometric Quadriceps Strength after the Application of Ultrasound-Guided Percutaneous Neuromodulation of the Femoral Nerve: A Case Series

2019 ◽  
Vol 02 (01) ◽  
pp. 39-45
Author(s):  
David Álvarez-Prats ◽  
Óscar Carvajal-Fernández ◽  
Néstor Pérez-Mallada ◽  
Francisco Minaya-Muñoz
Keyword(s):  
Femoral Nerve ◽  
Case Series ◽  
Low Frequency ◽  
Quadriceps Muscle ◽  
Quadriceps Strength ◽  
Isometric Strength ◽  
Ultrasound Guided ◽  
Early Recovery ◽  
The Us ◽  
Knee Pathology

Abstract Introduction For those individuals who have suffered an injury to the knee or undergone a surgical intervention, the early recovery of the muscle strength contraction properties of the quadriceps is essential for a favorable recovery and for a return to the activities of daily living and other work- or sports-related activities. Objectives To evaluate the changes in maximal isometric strength (MIS) of the quadriceps muscle after the application of ultrasound-guided percutaneous neuromodulation (US-guided PNM) on the femoral nerve. Materials and Methods A case series involving subjects who had previously presented unilateral knee pathology and were in the stage of recovery of quadriceps strength. The subjects were pain-free at the time of the dynamometry measurements, which were performed before and after the application of the US-guided PNM technique. The isometric measurement was performed using the KINEO dynamometry system, performing a preintervention measurement of the mean maximal isometric strength (mMIS) based on 3 repetitions (3 seconds contraction and 6 seconds relaxation). The US-guided PNM technique was performed on the femoral nerve, using the Physio Invasiva CE0120 device (Prim Physio, Madrid, Spain) and a GE Logiq e R7 ultrasound (GE Healthcare, Chicago, IL, USA). Results In total, 13 subjects participated in the present study. Significant changes were obtained (p < 0.001) in the mMIS of the quadriceps of the affected knee, which progressed from a mean strength of 25.91 kg (standard deviation [SD]: 7.17 kg) to a mean strength of 29.98 kg (SD: 9.06 kg). Discussion In subjects with knee pathology, the quadriceps muscle is inhibited despite being pain-free during the strength measurements. This process of inhibition can improve with the application of low frequency percutaneous electrical stimulation on the femoral nerve. This technique represents a complementary strategy for the recovery of the normal strength values in pathological knees with or without prior surgery. Conclusions Ultrasound-guided PNM is an effective technique for the reestablishment of quadriceps strength in inhibited muscles.

Extrapelvic Compression of the Femoral Nerve: An Uncommon Cause of Hip Pain

1996 ◽  
Vol 6 (3) ◽  
pp. 129-133
Author(s):  
H. Stalder ◽  
J. Romero ◽  
V. Dietz
Keyword(s):  
Hip Joint ◽  
Femoral Nerve ◽  
Clinical Signs ◽  
Quadriceps Muscle ◽  
Hip Pain ◽  
Lumbar Plexus ◽  
Sensory Loss ◽  
Short History ◽  
Lateral Aspect ◽  
History Of

The case of a patient with short history of unilateral hip pain due to compression of the lumbar plexus by a cyst arising from the hip joint is reported. Radiologically there were only mild signs of osteoarthritis of the affected hip but severe degenerative changes were found in the lumbar spine. There was atrophy of the quadriceps muscle of the affected limb with subsequent giving-way during gait and sensory loss on the lateral aspect of the thigh. The neurological and electromyographical examination suggested compression of the lumbar plexus. By sonography, computerized tomography and contrast radiographs, a finger shaped cyst was identified going from the ventromedial aspect of the hip joint between the iliopsoas, the pectineus, and the iliacus muscles respectively. After excision of the cyst, hip pain ceased and the signs of neural compression disappeared almost completely within 12 weeks. Histologically the specimen showed synovial tissue with cartilaginous debris. In cases of hip pain without sufficient radiological and clinical signs of osteoarthritis, femoral nerve compression should be excluded by neurological examination. To our knowledge, this is the first report about compression of the femoral nerve by an isolated extrapelvic cyst arising from the hip joint.

Pain reduction by dehydrated human amnion/chorion membrane allograft in nondiabetic leg ulcers might be an early indicator of good response: A case series

2020 ◽  
Vol 33 (4) ◽  
Author(s):  
Simon M. Mueller ◽  
Alexander A. Navarini ◽  
Peter Itin ◽  
Simon Schwegler ◽  
Severin Laeuchli ◽  
...  
Keyword(s):  
Case Series ◽  
Pain Reduction ◽  
Leg Ulcers ◽  
Human Amnion ◽  
Early Indicator

Score-Celebration Injuries among Soccer Players

2005 ◽  
Vol 33 (8) ◽  
pp. 1237-1240 ◽  
Author(s):  
Bülent Zeren ◽  
Haluk H. Öztekin
Keyword(s):  
Case Series ◽  
Adductor Muscle ◽  
Quadriceps Muscle ◽  
Self Control ◽  
Soccer Players ◽  
Level Of Evidence ◽  
Professional Soccer ◽  
Ligament Sprain ◽  
Serious Injury ◽  
And Behavior

Background Professional and amateur soccer players often perform dramatic on-field feats of celebration after scoring a goal. Injuries may occur during these activities. Purpose With the aim of preventing such “score-celebration injuries” in the future, the authors examine these events in professional soccer players and discuss potential avenues for prevention. Study Design Case series; Level of evidence, 4. Methods Over the course of 2 seasons (1996-1998), 152 soccer players were evaluated at an orthopaedic clinic for injuries incurred during matches. Nine players (6%) had injured themselves while celebrating after scoring goals in a match. The type of celebration, injury type, treatment, and mean duration of recovery were noted. Results Seven of the 9 patients were male professional soccer players with ages ranging between 17 and 29 years (mean age, 24 years). The injuries occurred when the playing ground was natural turf in 8 cases; most injuries occurred in the second half of the game. The types of celebration maneuvers were sliding (prone or supine) and sliding while kneeling in 5 cases, piling up on jubilant teammates in 3 cases, and being tackled while racing away in 1 case. Injuries included ankle, clavicle, and rib fractures; medial collateral ligament sprain; low back strain; hamstring and adductor muscle strain; quadriceps muscle sprain; and coccyx contusion. The mean duration for recovery was 6.2 weeks. Rival team players were usually not responsible for such trauma. Conclusion Exaggerated celebrations after making a goal, such as sliding, piling up, and tackling a teammate when racing away, can result in serious injury. In addition to general measures for preventing soccer injuries, coaches and team physicians should teach self-control and behavior modification to minimize the risk of such injuries. More restrictive rules, which penalize such behavior, may assist in the prevention of score-celebration injuries.

Pharmacokinetics of lidocaine after bilateral ESP block

2020 ◽  
Vol 46 (1) ◽  
pp. 86-89 ◽  
Author(s):  
Alessandro De Cassai ◽  
Claudio Bonanno ◽  
Roberto Padrini ◽  
Federico Geraldini ◽  
Annalisa Boscolo ◽  
...  
Keyword(s):  
Pain Treatment ◽  
Case Series ◽  
Ideal Body Weight ◽  
Compartment Model ◽  
Erector Spinae ◽  
Lumbar Spine Surgery ◽  
Perioperative Analgesia ◽  
Elimination Half ◽  
Wide Range ◽  
Rate Of Absorption

IntroductionErector spinae plane (ESP) block is an emerging interfascial block with a wide range of indications for perioperative analgesia and chronic pain treatment. Recent studies have focused their attention on mechanisms of action of ESP block. However, the pharmacokinetics of drugs injected in ESP is, as of now, uninvestigated. The aim of this brief report is to investigate the pharmacokinetics of lidocaine in a series of 10 patients.MethodsWe are reporting a case series of 10 patients undergoing bilateral ESP block for multilevel lumbar spine surgery.ESP was performed with 3.5 mg/kg of lidocaine based on ideal body weight. Lidocaine concentration was dosed at 5, 15, 30 min and at 1, 2 and 3 hours.ResultsTmax was 5 min for all the patients. Cmax ranged from 1.2 to 3.8 mg/L (mean: 2.59 mg/L). AUC0-3 was high (76%, on average) suggesting an almost complete bioavailability. Age had a negative correlation with T½ of lidocaine.ConclusionsLidocaine pharmacokinetic after ESP block is well-described by a two-compartment model with a rapid and extensive rate of absorption. Nevertheless, its peak concentrations never exceeded the accepted toxicity limit. Elimination half-life was slightly prolonged, probably due to the advanced age of some patients.

Poster 111: Effect of PTH 1-84 on the Increase in BMD and Pain Reduction of Patients With Osteoporotic Vertebral Fractures. A Case Series

PM&R ◽  
2010 ◽  
Vol 2 ◽  
pp. S54-S54
Author(s):  
Alba Gomez-Garrido ◽  
Silvia Caño ◽  
Carme Garcia-Ameijeiras ◽  
Ana Maria Leon ◽  
Mauricio Tovar-Felice
Keyword(s):  
Vertebral Fractures ◽  
Case Series ◽  
Pain Reduction ◽  
Osteoporotic Vertebral Fractures

scholarly journals Radial Flap in Reconstructions of the Hand - Case Series Study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Dejan Vulovic ◽  
Jefta Kozarski ◽  
Zeljko Curcic ◽  
Nenad Stepic ◽  
Milos Vucetic ◽  
...  
Keyword(s):  
Case Series ◽  
Fasciocutaneous Flap ◽  
Radial Forearm Flap ◽  
Soft Tissue Coverage ◽  
Local Skin ◽  
Aesthetic Result ◽  
Forearm Flap ◽  
Thickness Skin ◽  
Case Series Study ◽  
Radial Forearm

AbstractRadial forearm flap is an axial flap that has become an important technique in reconstructive surgery as a free flap or as a pedicled flap. Defects of the skin and other tissues on the hand are very common and most often they are work-related injuries. In deep defects, flap must be used, as well as in reconstruction of the amputated thumb. There are many flaps that provide adequate soft tissue coverage for the hand. Therefore, the aim of this paper is to present the results of the use of radial forearm flap in various reconstructions on the hand. The retrospective study included 35 patients who underwent reconstruction with radial forearm flaps due to defects of the skin and other tissues on the hand, in the period 1997-2019. Results and complications of the surgery were analyzed. The functional and aesthetic outcome was assessed using Michigan Hand Outcome Qusteionnarire. All patients were followed for a minimum of 1 year. Fasciocutaneous flap was the most commonly used (65.71%), followed by adiposofascial (20%) and osteocutaneous (14.29%). The size of the fasciocutaneous flap ranged from 2.2x3.1cm to 9x13.5cm. The majority of donor sites were closed with split-thickness skin grafts (56.52%), and less frequently with direct suture, local skin flap, and full-thickness skin graft. There were no complete flap losses in the study. Marginal necrosis was noted in 8.57%, and graft failure at the donor site in 14.29%. Secondary surgical procedures were performed in 13 patients. The functional-aesthetic result of the operation, based on the MHQ score, ranged from 31 (1/35) to 130 points (3/35). The ultimate aim of hand reconstruction is to restore sufficient function and form, also, closing the wound within three days following the injury is desirable. Meticulous intraoperative dissection of radial flap and early physical therapy after surgery are mandatory. The radial flap is a suitable method, especially for large and more distal skin defects on the hand, and a very good method for thumb reconstruction.

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