The estimated prevalence of osteoporosis in Bahrain: a multi-centered-based study.

OBJECTIVES: the primary aim of this study was to examine the prevalence and risk factors of low bone mineral density in Bahrain. METHODS: this was a retrospective study, which targeted a cohort of 4822 Bahraini subjects (mean age 59.36 years: 93% females). Demographic data and results of lumbar and femur DEXA scan for the targeted sample, over the period 2016-2018, were retrieved from four hospitals. RESULTS: The prevalence of low BMD was 62.3% (46.4% had osteopenia and 15.9% had osteoporosis). The highest rate of osteopenia was detected at the age group younger than 44 years. However, with increasing age, the rate of osteopenia declined, whereas osteoporosis increased (P < 0.001). Females were found to be at higher risk of developing both osteopenia (45.8%) and osteoporosis (18.1%) compared to males (39% and 12.4%, respectively) (P < 0.001). Postmenopausal women exhibited higher rates of low BMD (42.4% osteopenia, 22.3% osteoporosis) compared to elderly men (30.9% osteopenia, 9% osteoporosis). CONCLUSIONS: We reported high prevalence of osteopenia and osteoporosis in Bahrain. Low BMD was more common in females, especially in postmenopausal women. Highest prevalence of osteopenia happened at young age. Therefore, we advocate screening at younger age than previously recommended.

Comparison between Local Infiltration Analgesia and Ultrasound Guided Single Shot Adductor Canal Block Post Total Knee Replacement Surgery - A Randomized Controlled Trial.

CONTEXT: Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay. AIM: To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA. SETTINGS AND DESIGN: This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital. MATERIALS AND METHODS: Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h' postoperative period. The primary outcome measures were first 24 h' morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores. STATISTICAL ANALYSIS: Statistical analysis was performed using the Student's t-test, Mann-Whitney test, and Chi-square test. RESULTS: The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively (P = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h. CONCLUSION: Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA.

Impact of Intra-Articular Local Anesthesia Infiltration versus Femoral Nerve Block for Postoperative Pain Management in Total Knee Arthroplasty.

Background: Postoperative pain relief after total knee arthroplasty (TKA) can be attained by using several techniques such as intravenous analgesia, epidural analgesia, and peripheral nerve blocks that include femoral nerve and saphenous nerve. Several authors recommended intra-articular injection of local anesthetic (IALA) as a part of multimodal analgesia regimens for TKA instead of other techniques. Aims: The present study compares IALA technique efficacy with single-shot femoral nerve block (FNB) as part of multimodal analgesia regimen in TKA patients for postoperative pain management. Setting and Design: Perioperative care, randomized double-blind comparative study. Subjects and Methods: We recruited a total of 60 patients scheduled for unilateral total knee replacement under spinal anesthesia. Subjects were allocated randomly into two groups FNB and IALA receiving ultrasound-guided FNB and Intra-articular local anesthesia and morphine mix infiltration, respectively. Twenty-four hour postoperative morphine consumption through patient-controlled analgesia was the primary outcome measure in our study. Secondary outcome measures were pain scores, nausea and vomiting. Statistical Analysis: Chi-square test, Mann-Whitney test. Results: The amount of morphine consumed at the end of 24 h was noted to be higher in IALA group as compared to FNB (FNB - 16.03 ± 9.37 mgs; IALA - 23.60 ± 13.73 mgs P = 0.03). Visual analog score at 24 h with knee flexion was better in FNB group (FNB - 1.27 ± 1.43; IALA 2.42 ± 2.54, P = 0.04). Conclusion: FNB technique provides better analgesia in comparison to IALA for postoperative pain management in terms of PCA morphine consumption.