Post operative pain management in shoulder surgery: Suprascapular and axillary nerve block by arthroscope assisted catheter placement.

BACKGROUND: Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Various treatment modalities have been used for pain management, but they have some limitations, side effects and risks. Throughout intraoperative and postoperative period, nerve blocks have been used more popularly than others because of efficacy. For the regional nerve block, local anesthetic should be infiltrated close to the nerve for maximum effect. Consequently, aim of this study was to evaluate analgesic efficacy when catheters are placed with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia. MATERIALS AND METHODS: 24 patients (5 males, 19 females; mean age: 54.3 years) who underwent arthroscopic repair of rotator cuff between June 2014 and September 2014 and were catheterized to block suprascapular and axillary nerves during shoulder arthroscopy were included in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2. RESULTS: Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.38 ± 0.77, 0.44 ± 0.42, 0.58 ± 0.42, 0.63 ± 0.40, 0.60 ± 0.44, 0.52 ± 0.42, and 1.55 ± 0.46, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, comparison of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P < 0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38 ± 3.21 and 3.75 ± 0.85, respectively. CONCLUSION: These results demonstrated that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients' satisfaction could be improved.

A new, objective radiographic classification system for the assessment of treatment results in developmental dysplasia of the hip.

The new, objective radiographic classification system for the assessment of treatment results in developmental dysplasia of the hip includes three quantitative parameters: centre-edge angle of Wiberg, acetabular angle of Sharp and the centre-trochanter distance. Each parameter is divided into three subgroups and assigned a point score (0, 1 and 2) according to their previously determined values. Besides this, three corrective items on the existence of middle/posterior acetabular deficiency, secondary operation and resubluxation/redislocation are added to the classification system and in the presence of any of these items, one point for each item is extracted from the total points. A total of five or six points represents a satisfactory outcome and less than five points, an unsatisfactory outcome. The new system was found to have adequate intraobserver and interobserver agreement levels. It was also observed that, the gold standard Severin system could lead the raters to obtain somewhat more optimistic results with respect to the new system before and after skeletal maturity. It was concluded that the present system could evaluate both the final radiographic status of the hip and the success or failure of the primary treatment and could be capable of leading orthopaedic surgeons to speak the same language while assessing radiographic results in developmental dysplasia of the hip.

Is concomitant bone surgery necessary at the time of open reduction in developmental dislocation of the hip in children 12-18 months old? Comparison of open reduction in patients younger than 12 months old and those 12-18 months old.

It is controversial to perform bone surgery at the time of open reduction in developmental dislocation of the hip in children 12-18 months old. The purpose of this study is to investigate whether concomitant bone surgery is necessary in patients treated with medial open reduction in this age range. Patients that were under 12 months of age at the time of open reduction were compared with patients that were 12-18 months old. Forty-four hips of 30 patients treated with open reduction through Ferguson's medial approach have been included in the study. Mean follow-up was 19.6 years (13-27.5). Age at the time of open reduction was less than 12 months in 21 hips (group A) and 12 months or more in 23 hips (group B). There was no significant difference between two groups concerning avascular necrosis or unsatisfactory radiological outcome (Severin's groups III and IV). A higher rate of secondary bone surgery was necessary in group B than in group A. Although secondary bone surgery is needed at a higher frequency in children 12-18 months old, the radiological outcome is not significantly different for patients younger than 12 months. Therefore, the recommendation of concomitant bone surgery on a routine basis during open reduction in developmental dislocation of the hip in children 12-18 months old is debatable.

Open reduction through a medial approach in developmental dislocation of the hip: a follow-up study to skeletal maturity.

Forty-four developmentally dislocated hips occurring in 30 patients with an average age at initial surgery of 10.7 (range 2-19) months underwent medial open reduction by Ferguson's approach. All patients were skeletally mature at most recent evaluation. Mean follow-up was 19.8 (range 13-27.5) years. No redislocation or sub-luxation occurred. Additional surgery was required in 11 hips (25%). Avascular necrosis was detected in nine hips (20%). The acetabular index was decreased and the center-edge angle was increased during follow-up. Excellent or good outcome (Severin group 1 or 2) was observed in 79% of the hips at skeletal maturity. At the most recent evaluation, all but two patients had the highest score on the Iowa Hip Rating. The authors conclude that open reduction through the medial approach is effective in developmental dislocation of the hip. Follow-up until skeletal maturity is necessary for an accurate assessment of treatment.

Treatment of developmental dysplasia of the hip with Pavlik harness: prospective study in Graf type IIc or more severe hips.

Successful treatment of developmental dysplasia of the hip (DDH) is associated with early diagnosis and appropriate treatment. In this prospective study, the results of the treatment with Pavlik harness followed by an abduction brace in patients with severe DDH were presented. Twenty-two hips of 18 patients with a mean age of 14.8+/-5.9 weeks (range, 6-26) when diagnosed were followed for an average of 24.2+/-10.8 months (range, 10-46). The hips were staged according to the classification of Graf with ultrasonography and Pavlik harness was instituted as the first line of treatment in all hips. If there was no improvement of ultrasonographic stage at the third week follow-up the harness treatment was discontinued. After the infant became too large for Pavlik harness an abduction brace was used. In all but one hip the treatment was successful (95.4%). In two hips type I avascular necrosis was noted. Of the dislocated hips 90% were reduced. The Pavlik harness is a safe and effective method of treatment of severe DDH in infancy if potential pitfalls are avoided.