Effect of cryotherapy on pain and analgesic consumption after wrist or thumb surgery.

Cryotherapy has demonstrated its efficacy in post-traumatic soft tissue pain, through its anti-inflammatory action. Its postoperative use has also been the topic of many studies and has now proved its efficacy in indications such as ligament or knee arthroplasty surgery. The aim of this study was to analyze the effect of cryotherapy on pain and analgesic consumption after wrist or base of the thumb surgery. We prospectively included 60 patients from March 2017 to May 2018. All these patients had undergone wrist or base of the thumb surgery involving a bone procedure. Thirty patients were managed with cryotherapy (the Handfreez® splint), 30 patients were included in the control group with conventional immobilization. The data collected included a visual analogue scale (VAS), and analgesic and non-steroidal anti-inflammatory drug (NSAID) consumption, both during the hospital stay and then at home for one week. The results from the two groups were compared. During the hospital stay, morphine consumption was significantly lower in the cryotherapy group (p = 0.04). At home, NSAID consumption was significantly lower in the cryotherapy group (p = 0.009). The VAS score was not significantly different between the two groups. In our study, we demonstrated the benefits of cryotherapy on consumption of analgesics and NSAIDs after bone surgery of the wrist or the base of the thumb.

Does the repetition over a short time of a microsurgical suture improve its reliability?

Our hypothesis was that immediate repetition of a microsurgery-suturing task will improve its execution and outcome. This was an experimental animal study. Ten surgeons were divided into two groups of five surgeons. Each performed two end-to-end carotid anastomoses on the same rat, one after the other. The anastomosis was evaluated by the surgeon and an instructor. The primary endpoint was permeability. The outcome was evaluated using an objective and subjective assessment grid yielding 1 to 3 points per item. The total scores for each of the 10 surgeons were used to compare the anastomosis of carotid 1 versus 2, using the ratings given by the surgeon and the instructor. Twenty anastomoses were performed, but 1 rat died intraoperatively, leaving 18 anastomoses for evaluation. No significant differences were found on the main endpoint of permeability, with all anastomoses being permeable. The surgeon's self-assessment was significantly better for the second carotid artery (P=0.05), but this was not confirmed by the proxy assessment (instructor). The analysis by subgroups-morning versus afternoon-found the second carotid anastomosis was significant better in the self-assessment and proxy assessment for the morning group (P<0.001, P=0.024). There was no significant difference in clamping times. The immediate repetition of a microsurgical procedure seems to favor its execution, which leads us to propose that the more difficult or important anastomosis should be done after an easier or less important one during complex surgeries. LEVEL OF EVIDENCE: 2B.