Comparison of local infiltration analgesia and interscalene block for postoperative pain management in shoulder arthroscopy: a prospective randomized controlled trial

Background/aim: The aim of this study was to compare the effects of local infiltration analgesia and interscalene brachial plexus block techniques on postoperative pain control and shoulder functional scores in patients undergoing arthroscopic rotator cuff repair. Materials and methods: Sixty patients who underwent arthroscopic rotator cuff repair were prospectively included in the study. Patients were randomly divided into two groups. Group 1 was comprised of patients who had interscalene brachial plexus block, while group 2 was comprised of patients who had local infiltration analgesia. In group 1, interscalene block was applied with 20 mL 0.5% bupivacaine. In group 2, the Ranawat cocktail was used for local infiltration analgesia. Sixty milliliters of Ranawat cocktail was applied to the subacromial space and glenohumeral joint in equal amounts. Postoperative pain was assessed by the VAS score. Functional scores of the shoulder were also evaluated by Constant­Murley and UCLA scores. The time of first analgesic requirement and total analgesic consumption in the postoperative period were assessed. Results: The first analgesic requirement was significantly late in the interscalene brachial plexus block group (p = 0.000). There was no statistically significant difference between the groups in terms of total analgesic consumption (p = 0.204). In the postoperative 6th h, the VAS score was 2.43 in the interscalene brachial plexus block group, whereas 2.86 in the local infiltration analgesia group (p = 0.323). There was no statistically significant difference between the groups in terms of Constant­Murley shoulder and UCLA scores in the 3rd postoperative month (respectively, p = 0.929, p = 0.671). Besides, postoperative VAS scores and functional scores were negatively correlated (p < 0.01). Conclusion: Local infiltration analgesia is an effective alternative to interscalene brachial plexus block for postoperative pain management and total analgesic consumption in arthroscopic rotator cuff repair. However, the interscalene brachial plexus block provides a longer postoperative painless period.

Reconstruction of Foot Postaxial Polydactyly Using the On-top Plasty: A Case Report.

Polydactyly is a common congenital hand, foot, or both anomalies characterized by the presence of extra fingers. Postaxial polydactyly is the most common congenital malformation consisting of the lateral or fibular aspect of the foot. Extra finger excision in the treatment of foot polydactyly is considered the basic procedure in surgery. However, in some cases more complex surgeries should be preferred. In this study, the "on-top plasty" method with a minimally invasive approach is presented in a case of complex foot postaxial polydactyly.

The arthroscopical and radiological corelation of lever sign test for the diagnosis of anterior cruciate ligament rupture.

The aim of the current study was to evaluate the sensitivity of the lever sign test and the widely used basic tests of the Lachman, anterior drawer and pivot shift tests, both under anaesthesia and without anaesthesia, according to the gold standard diagnostic arthroscopic results in patients undergoing anterior cruciate ligament reconstruction. The study included 117 patients, diagnosed with ACL tear which was definitively determined during an arthroscopic surgical procedure applied. Before anaesthesia and while under anaesthesia, the Lachman, anterior drawer, pivot shift and lever sign tests were applied to all patients. Evaluation was made of MR images for each patient and documented. The patients comprised 96 males and 21 females, witha mean age of 25.8 ± 5.9 years (range, 17-45 years). Total tear was determined in 82 cases, anteromedial (AM) bundle in 14, posterolateral (PL) bundle in 13 and elongation in 8. Pre-anaesthesia positivity was found in lever sign at 94.2 %, Lachman at 80.5 %, pivot shift at 62.3 % and anterior drawer at 60.1 %. These rates were determined after anaesthesia as lever sign 98.4 %, Lachman 88.7 %, pivot shift 88.3 % and anterior drawer 84.2 %. The lever sign test can be easily applied clinically and it seems to have higher sensitivity than the Lachman test which is the basis of classic information, it should be included in routine clinical practice. In the light of the results of this study, further studies are required to review the accepted view that the Lachmann test is the most reliable test.

Assessment of recurrence rates in papillary thyroid microcarcinoma patients with and without histopathological risk factors after radioiodine ablation treatment.

AIM: We aimed to assess the recurrence rates of papillary thyroid microcarcinoma in patients with and without histopathological risk factors after radioiodine (RAI) ablation treatment. MATERIALS AND METHODS: A total of 357 papillary thyroid microcarcinoma patients who were referred to Ankara University Medical School, Department of Nuclear Medicine for RAI ablation treatment after total or near-total thyroidectomy were included in the study. All patients received RAI ablation treatment 4-6 weeks after surgery. After RAI ablation, patients were monitored every 3 months within the first 6 months and then every year. RESULTS: During follow-up, sixth-month iodine-131 (I-131) whole-body scans showed successful ablation in 333 (93.3%) patients. However, one (0.2%) patient had a focal lung uptake on the sixth-month I-131 whole-body scan, although the postablative scan gave no evidence of lung metastasis. Lung metastasis of this patient was treated with a second dose of RAI. The mean follow-up period was 124 (min-max: 6-216) months. No recurrence was detected in 344 (96.3%) patients during the follow-up period. However, in 13 (3.6%) patients, new recurrence or metastasis had developed. Lymph node metastasis was detected using fluorine-18 flourodeoxyglucose PET/computed tomography in four and using neck ultrasound in eight of them. The metastasis rates of patients with papillary microcarcinoma at a single focus with no thyroid capsule or lymphovascular invasion (n=268) and those of patients with thyroid capsule and/or lymphovascular invasion (n=89) were compared. Metastasis was seen in six and seven patients in those groups, respectively. The difference in metastasis rate between the two groups was statistically significant (2.2 vs. 9.2%, P=0.008). CONCLUSION: RAI ablation is beneficial in the management of papillary thyroid microcarcinoma patients with histopathological risk factors. It also improves the sensitivity of thyroglobulin and antithyroglobulin, facilitating easier and safer follow-up.