Efficiency of the Local Infi ltration Analgesia Method in Total Knee Artroplasty Surgeries.

PURPOSE OF THE STUDY: Postoperative pain after total knee arthroplasty (TKA) is severe because of bone and soft tissue trauma during the surgery and is diffi cult to control with oral analgesics. The primary aim of the study was to investigate the effects of the local infi ltration anesthesia (LIA) method on postoperative analgesia quality and opioid consumption in patients undergoing TKA. The secondary aims were to evaluate knee fl exion angle, side effects, and patient satisfaction. MATERIAL AND METHODS Total 40 patients, who underwent unilateral TKA surgery under spinal anesthesia were included in the prospective randomized study. Patients who underwent patient-controlled intravenous analgesia (PCA) (Group A) or LIA + PCA (Group B), were divided into two groups, randomly. For LIA application, 0.25% bupivacaine solution 150 mg in 60 ml volume was used. The postoperative pain was evaluated in 48th hour after the recovery of motor block, and during exercise at 24, 36, and 48 hours by using the visual analogue scale (VAS). An additional morphine was administered with the PCA device when VAS ≥ 4. The total amount of morphine consumption and the side effects were recorded. The knee fl exion joint angles at the 48th hour and the patients' satisfaction was recorded. RESULTS Resting VAS values were lower in Group B in the fi rst 24 hours (p<0.05). However, the 36 th and 48th hour measurements were not different in groups. The exercises VAS values and the total morphine consumption were signifi cantly higher in Group A at 24, 36 and 48 hours. The knee fl exion joint angles in Group B were higher than Group A in terms of 48th hour. The incidence of side effects was not different in the two groups. Patients' satisfaction was higher in the PCA+ILA group (p<0.05). DISCUSSION In many studies the periarticular injection with multimodal drugs has been shown to reduce the requirements for analgesia, with no apparent risks, following TKA, similar to our results. LIA reduced postoperative opioid use and increased exercise tolerance. CONCLUSIONS In our study, we found that LIA reduced pain scores and opioid consumption during rest and exercise after TKA operation. For TKA patients where post-operative exercise is particularly important, we recommend the easy-to-use LIA method for a pain-free and unrestricted postoperative period. KEY WORDS: total knee arthroplasty, local infi ltration analgesia, postoperative analgesia, knee fl exion angle, opioid consumption.

Retraction Note: Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

The Editor-in-Chief has retracted this article [1] because it shows significant overlap with a previously published article by Pladzyk et al. [2].

Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

AIM: Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective in stopping adductor spasm during spinal anesthesia. METHODS: Forty-one patients undergoing (transurethral resection of bladder tumor) TUR-BT with spinal anesthesia who required (obturator nerve block) ONB were included in the study. After spinal anesthesia, ONB was performed with an inguinal approach (group 1) (n = 21) or an intravesical approach (group 2) (n = 20). In this study, we used 10 ml of 2 % lidocaine to perform the ONB. RESULTS: The mean age of patients was 60.8 ± 7.5 years. The groups were not different with regards to age, tumor localization and tumor size. There were two bladder perforations in group 1 and six perforations in group 2 (p = 0.130). However, the efficacy of ONB was significantly higher in inguinal approach group compared to intravesical approach group (p = 0.032). CONCLUSION: Obturator nerve block plays an additive role on the quality of analgesia for bladder surgery. Our data suggests that identification of the obturator nerve with ultrasound is easy and the block can be assessed by observing avoidance of bladder spasm.

Effect of sedation with midazolam or propofol on patient's comfort during cancer chemotherapy infusion: a prospective, randomized, double-blind study in breast cancer patients.

Nausea, vomiting and anxiety related to administration of cancer chemotherapy remain significant problems. This randomized, clinical trial was undertaken to evaluate the effect of sedation on the patient's comfort during chemotherapy infusion in patients with breast cancer. Forty-five breast cancer patients were randomized into three groups: Group I--chemotherapy, control, Group II--midazolam+chemotherapy, and Group III--propofol+chemotherapy. Nausea occured in 87% and vomiting in 13% of the patients in the control group, while none of the sedated subjects had these side-effects, although 76% of them had experienced then during previous cycles of chemotherapy. Compared with the control group, post-chemotherapy anxiety scores also improved with the addition of midazolam or propofol. Eighty percent of the subjects declared that they would prefer the sedative-containing regimen for their further cycles. Sedation with midazolam or propofol may improve the patient's comfort, and provide better control of chemotherapy-related side effects during chemotherapy infusion in breast cancer patients.