Effects of the nontourniquet combined with controlled hypotension technique on pain and long-term prognosis in elderly patients after total knee arthroplasty: a randomized controlled study.

PURPOSE: The aim of this study was to confirm the alleviating effects of the nontourniquet technique on the postoperative acute and chronic pain of patients after total knee arthroplasty (TKA). METHODS: 122 elderly patients undergoing TKA were randomly divided into two groups: group T (n = 58) and group H (n = 64). An electronic inflatable tourniquet was used during TKA in group T. The patients in group H received controlled hypotension but without tourniquet use during the operation. The numeric rating scale (NRS) score was used to evaluate pain level on day 1, day 2, day 3 and day 7 after the operation, and the incidence of chronic pain was judged at 3-month and 1-year follow-ups, and functional recovery of the knee joint was estimated by the active range of knee joint motion (AROM) at the same time points. Cognitive function was assessed by the montreal cognitive assessment scale (MoCA) for 7 days after operation. RESULTS: There were no significant differences in the NRS scores and AROM for 7 days after surgery. The incidence rate of chronic pain in group H (25.0%) was lower than that in group T (41.4%) and the AROM in group H was greater at one year follow-up. The MoCA score in group H was lower than that in group T on day 1 and day 2. CONCLUSION: The nontourniquet combined with controlled hypotension technique can alleviate chronic pain and promote the long-term rehabilitation of patients after TKA.

Effect of prophylactic dexamethasone on nausea and vomiting after laparoscopic gynecological operation: meta-analysis.

BACKGROUND: Sex of female and laraproscopic surgery are both risk factors related to postoperative nausea and vomiting, and dexamethasone is used as anti-emetic in some operations. A meta-analysis of randomized trials was performed to determine the effect of prophylactic dexamethasone administration on postoperative nausea and vomiting, pain and complications in patients undergoing laparoscopic gynecological operation. METHODS: A systematic literature search was conducted to identify all randomized clinical trials. The primary outcome was the incidence and severity of postoperative nausea and vomiting. The secondary outcomes include postoperative pain and complications. RESULTS: Totally 1801 patients were enrolled in 11 eligible randomized trials comparing effect of prophylactic dexamethasone administration on postoperative nausea and vomiting with placebo. The pooled incidence of nausea, vomiting, nausea and vomiting, and rescue anti-emetic was significantly lower in dexamethasone group than placebo group during post-anesthesia care unit (10.5% vs. 18.2%, OR 0.51, 95% CI 0.31-0.84; 6.5% vs. 17.1%, OR 0.31, 95% CI 0.17-0.56; 17.0% vs. 35.4%, OR 0.33, 95% CI 0.21-0.50; 6.7% vs. 23.3%, OR 0.22, 95% CI 0.10-0.49, P < 0.00001) and within the first postoperative 24 hours (25.2% vs. 40.3%, OR 0.46, 95% CI 0.32-0.66; 14.4% vs 36.6%, OR 0.27, 95% CI 0.19-0.40; 33.0% vs. 69.0%, OR 0.18, 95% CI 0.13-0.26; 21.0% vs 51.1%, OR 0.26, 95% CI 0.16-0.41, P < 0.00001). No significant difference was found about the incidence of rescue analgesia between dexamethasone group and placebo group (48.5% vs 56.4%, OR 0.68, 95% CI 0.40-1.18, P = 0.17). CONCLUSION: Prophylactic dexamethasone administration decreases the incidence of nausea and vomiting after laparoscopic gynecological operations during post-anesthesia care unit and within the first postoperative 24 hours. (286 words) Postoperative nausea and vomiting are the most common complications after anesthesia and surgery, and both sex of female and type of laparoscopic operation are risk factors. It is certain of a remarkably high incidence after laparoscopic gynecological surgery, which is reported as nearly 70% within the first postoperative 24 hours. It is very important to find an effective treatment to alleviate postoperative nausea and vomiting.