Exparel/Peripheral Catheter Use in the Ambulatory Setting and Use of Peripheral Catheters Postoperatively in the Home Setting.

PURPOSE OF REVIEW: With the increasing number of ambulatory surgeries being performed, regional anesthesia has become an increasingly popular anesthetic modality, and many choices exist to provide efficient, effective quality perioperative analgesia. In this paper, we will review the various regional anesthesia options in addition to the advantages and disadvantages of each. Lastly, we will discuss liposomal bupivicaine, a long acting local anesthetic, and its future role in the anesthesiologist's armamentarium. The aim of the publication is to provide a general overview of regional anesthesia as well as to discuss the advantages and disadvantages of this modality. Additionally, we sought to review the basics of liposomal bupivicaine as well as the relevant literature. RECENT FINDINGS: The results regarding liposomal bupivicaine are mixed and mainly focuses on local infiltration and intra-articular injections. There are no known studies specifically comparing liposomal bupivicaine to bupivicaine hydrochloride in ultrasound-guided nerve blocks. There is some encouraging data regarding liposomal bupivicaine, but further studies are needed before it is adopted as a mainstay of treatment. In addition to efficacy, additional investigations are needed to evaluate cost as this could be a major impediment to its implementation.

Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review.

BACKGROUND: Massive endoprostheses provide orthopaedic oncologists with many reconstructive options after tumor resection, although failure rates are high. Because the number of these procedures is limited, failure of these devices has not been studied or classified adequately. This investigation is a multicenter review of the use of segmental endoprostheses with a focus on the modes, frequency, and timing of failure. METHODS: Retrospective reviews of the operative databases of five institutions identified 2174 skeletally mature patients who received a large endoprosthesis for tumor resection. Patients who had failure of the endoprosthesis were identified, and the etiology and timing of failure were noted. Similar failures were tabulated and classified on the basis of the risk of amputation and urgency of treatment. Statistical analysis was performed to identify dependent relationships among mode of failure, anatomic location, and failure timing. A literature review was performed, and similar analyses were done for these data. RESULTS: Five hundred and thirty-four failures were identified. Five modes of failure were identified and classified: soft-tissue failures (Type 1), aseptic loosening (Type 2), structural failures (Type 3), infection (Type 4), and tumor progression (Type 5). The most common mode of failure in this series was infection; in the literature, it was aseptic loosening. Statistical dependence was found between anatomic location and mode of failure and between mode of failure and time to failure. Significant differences were found in the incidence of failure mode Types 1, 2, 3, and 4 when polyaxial and uniaxial joints were compared. Significant dependence was also found between failure mode and anatomic location in the literature data. CONCLUSIONS: There are five primary modes of endoprosthetic failure, and their relative incidences are significantly different and dependent on anatomic location. Mode of failure and time to failure also show a significant dependence. Because of these relationships, cumulative reporting of segmental failures should be avoided because anatomy-specific trends will be missed. Endoprosthetic design improvements should address failure modes specific to the anatomic location.

A comparison of two microbial detection methods used in aseptic processing of musculoskeletal allograft tissues.

Tissues from 78 musculoskeletal donors were concurrently tested for microorganisms using both a swab and liquid culture method. An aggregate total of 20 organisms were detected by both methods. The swab detected 4/20 organisms while the liquid culture detected 18/20 organisms. The swab method yielded sensitivity and negative predictive values of 20 and 92.3%, respectively. Comparatively, the liquid culture displayed a sensitivity of 90% and a negative predictive value of 99%. These results clearly demonstrate that the liquid culture method is superior to swab cultures in microbial detection. Additional studies are necessary to determine the optimal culture conditions for different types of tissues when utilizing the liquid culture method.