A lmost 70% of operative procedures in North America are currently performed in an ambulatory setting.1 Despite advances in surgical techniques and modern methods of analgesia, 45% of patients suffer pain at home after ambulatory surgery, 2 and moderate to severe pain intensity at home is reported by 30% of ambulatory patients.3 Inadequate relief of pain after ambulatory surgery increases morbidity and health care costs and reduces patients' quality of life.4,5 To improve postoperative pain relief, an integrative approach combining pharmacologic methods and various complementary nonpharmacologic analgesic techniques has been recommended.6 Auricular acupuncture holds promise, as it is an easily performed technique that might be effective for treatment of both preoperative anxiety and postoperative pain in patients undergoing ambulatory surgery.7,8 However, there are reasonable doubts in the scientific community concerning the specificity of acupuncture, 9 because the large randomized trials on auricular acupuncture for treatment of cocaine and alcohol dependence have found no difference between treatment and invasive needle control. 10,11Thus, after refining the methodology in a pilot study, 12 we performed a randomized controlled trial to compare the postoperative analgesic effect of auricular acupuncture with invasive needle control in patients after ambulatory knee surgery. MethodsThis prospective, patient-and evaluator-blinded, controlled study was performed between August 2003 and September 2004 at the Ambulatory Orthopedic Surgery Center of the Ernst Moritz Arndt University, Greifswald, Germany. The study was approved by the university's ethics committee. Consecutive patients scheduled for arthroscopic ambulatory knee surgery under general anesthesia (without premedication) were enrolled in the study. Exclusion criteria were age younger than 18 years or older than 70 years; American Society of Anesthesiologists physical status III (severe systemic disease with functional limitation); history of opioid, sedative or hypnotic medication or excess alcohol use; inability to understand the consent form or how to use a visual analogue scale for pain measurement; local auricular infection or significant auricular deformation; or presence of prosthetic cardiac valves. Patients were withdrawn from the study if it was necessary to change the perioperative analgesia scheme, if the arthroscopic procedure was turned into open knee surgery or if the patient was unexpectedly admitted to hospital after the procedure.On the day before surgery the patients were told that they would receive auricular acupuncture at specific points or Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial Background: Auricular acupuncture is a promising method for postoperative pain relief. However, there is no evidence for its use after ambulatory surgery. Our aim was to test whether auricular acupuncture is better than invasive needle control for complementary analgesia after ambulatory knee surgery. Methods:O...

Auricular acupuncture (AA) is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points) or sham procedure (three non-acupuncture points on the auricular helix) before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy.

Population-based cohort study. Objective. We examined associations between common lumbar degenerative changes observed on magnetic resonance imaging (MRI) and present or future low back pain (LBP). Summary of Background Data. The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse. Methods. Participants (n ¼ 3369) from a population-based cohort study were imaged at study entry, with LBP status measured at baseline and 6-year follow-up. MRI scans were reported on for the presence of a range of MRI findings. LBP status was measured on a 0 to 10 scale. Regression models were used to estimate the cross-sectional and longitudinal associations between individual and multiple MRI findings and LBP severity.Separate longitudinal analyses were conducted for participants with and without baseline pain.Results. MRI findings were present in persons with and without back pain at baseline. Higher proportions were found in older age groups. 76.4% of participants had a least one MRI finding and 8.3% had five or more different MRI findings. Crosssectionally, most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings (ranging from 0.06 for high intensity zone to 0.83 for spondylolisthesis). In the longitudinal analyses, we found most MRI findings were not associated with future LBPseverity regardless of the presence or absence of baseline pain. Compared to zero MRI findings, having multiple MRI findings (five or more) was associated with mildly greater pain-severity at baseline (0.84; 0.50-1.17) and greater increase in pain-severity over 6 years in those pain free at baseline (1.21; 0.04-2.37), but not in those with baseline pain (À0.30; À0.99 to 0.38). Conclusion.Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0 to 10 pain scale.

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BackgroundThe number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision.MethodsPatients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department’s point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins.ResultsThe average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p < .001 and p = 0.019) for ex- and implantation (€4147 vs. €6680 and €429 vs. €306) while length of stay and reimbursement were comparable.ConclusionsThis is the first detailed analysis of the hospital department’s cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.