Surgical predictors of acute postoperative pain after hip arthroscopy.

BACKGROUND: Pain following hip arthroscopy is highly variable and can be severe. Little published data exists demonstrating reliable predictors of significant pain after hip arthroscopy. The aim of this study was to identify influence of intraoperative factors (arthroscopic fluid infusion pressure, operative type) on the severity of postoperative pain. METHODS: A retrospective review of 131 patients who had received a variety of arthroscopic hip interventions was performed. A standardized anaesthetic technique was used on all patients and postoperative pain was analysed using recovery pain severity outcomes and analgesic use. A multivariate logistic regression analysis was performed on intraoperative factors including patient age, sex and BMI, arthroscopic infusion pressures (40 vs 80 mm Hg), amount of fluid used, length of surgery and types of arthroscopic interventions performed. Thirty six patients were also prospectively examined to determine arthroscopic fluid infusion rates for 40 and 80 mm Hg infusion pressures. RESULTS: Use of a higher infusion pressure of 80 mm Hg was strongly associated with all pain severity endpoints (OR 2.8 - 8.2). Other significant factors included hip arthroscopy that involved femoral chondro-ostectomy (OR 5.8) and labral repair (OR 7.5). Length of surgery and total amount of infusion fluid used were not associated with increased pain. CONCLUSIONS: 80 mm Hg arthroscopic infusion pressures, femoral chondro-osteoectomy and labral repair are strongly associated with significant postoperative pain, whereas intraoperative infusion volumes or surgical duration are not. Identification of these predictors in individual patients may guide clinical practice regarding the choice of more invasive regional analgesia options. The use of 40 mm Hg arthroscopic infusion pressures will assist in reducing postoperative pain.

Assessment of the quality of web-based information on bunions.

BACKGROUND: The Internet provides a large source of health-related information for patients. However, information on the Internet is mostly unregulated, ranging from factually correct to misleading or contradictory information. The objective of this study was to determine the quality of information available on World Wide Web on the topic of bunions. METHODS: Websites were identified using 3 search engines (Google, Yahoo, and MSN) and the search term bunions. The first 30 websites in each search were analyzed. Websites were assessed using the validated DISCERN rating instrument to determine the quality of health content and treatment information. The DISCERN tool possesses moderate to very good strength of interobserver agreement, ranging from .41 to .82. RESULTS: A total of 90 websites were assessed and studied. Forty-eight sites were duplicated, leaving 42 unique sites. Of these, 60% (25/42) provided patient-related information, 21% (9/42) were advertisements, 7% (3/42) promoted medical centers, 5% (2/42) were dead links, 5% (2/42) were news articles, and 2% (1/42) was doctor's information. In determining the quality of unique sites, of a maximum score of 5, the average overall DISCERN score was 2.9 (range, 1.8 to 4.6). Only 24% (10/42) of websites were classified as "good" or "excellent." Although most websites contained information on symptoms, causes, risk factors, investigations, and treatment options on bunions, 60% (25/42) did not provide adequate information on the benefits for each treatment, 45% (19/42) did not contain any risks of treatment, and 76% (32/42) did not describe how treatment choices affect overall quality of life. The sources of information were clear in 33% (14/42), and the date when this information was reviewed was given in only 50% (21/42). Only 29% (12/42) of websites had been updated within the past 2 years. CONCLUSIONS: Overall, the quality of patient information on bunions varies widely. We believe clinicians should guide patients in identifying the best possible and genuine information on the World Wide Web. CLINICAL RELEVANCE: Patients are commonly using the internet as an information resource, in spite of the highly variable quality of this information. They should be encouraged to exercise caution and to utilize only well-known sites.