Efficacy of repeated administration of intravenous acetaminophen for pain management after total knee arthroplasty.

Intravenous acetaminophen is an integral component of multimodal postoperative pain management. This prospective study aims to assess the efficacy of the repeated administration of intravenous acetaminophen and the impact on postoperative patient satisfaction with postoperative pain management after total knee arthroplasty (TKA). We enrolled 98 patients scheduled for unilateral TKA. Patients were randomly assigned to receive either 1000 mg of intravenous acetaminophen at 6-hour intervals (AAP group) or not to receive intravenous acetaminophen (control group). All patients underwent single-shot femoral nerve block after general anesthesia, as well as intraoperative periarticular infiltration of analgesia prior to implantation. The primary outcome was the postoperative numerical rating scale (NRS) pain score at rest. The NRS score was measured just before the administration of study drugs, immediately after arrival in the ward (time 0), and at 6, 12, 18, 24, and 48 h (time 1 to time 5, respectively) postoperatively. We also evaluated the mean doses of rescue opioid use for 24 h postoperatively. At time 5, the AAP group had significantly improved mean NRS score than controls (3.0 vs. 4.0; P < 0.01). Rescue opioid use was significantly lower in the AAP group for 24 hours compared to controls (0.3 µg vs. 0.9 µg; P < 0.01). Repeated intravenous acetaminophen administration after TKA may provide better analgesia and reduce opioid use.

[The choice of antibiotics for prophylaxis of postoperative infections in the field of orthopaedics. Clinical experience with cefoxitin].

The clinical effects of cefoxitin (CFX) were evaluated in the prophylaxis of postoperative infections in the field of orthopaedics. The clinical response was good in 46 out of 50 patients; an efficacy rate of 92%. Four patients (8%) who did not respond to CFX were suffering from infections due to Mycobacterium tuberculosis (1), suspected Pseudomonas aeruginosa (1), and infection of unknown organism (2). A review was also made of recent trends among clinically isolated bacterial strains and their susceptibility to antibiotics in the field of orthopaedics. CFX is recommended as an antibiotic of first choice for the prophylaxis of postoperative infections in the field of orthopaedics.