These findings in a rat model suggest that the use of stem cells enhances healing after Achilles repair and that embedding of stem cells directly into suture offers sustained early benefit to tendon healing.
When climbing stairs, there are 2 practical strategies, contact each step with alternating feet (single) or contact every other step (double) with alternating feet. Our purpose was to evaluate the metabolic cost and muscular activity of these single and double stair-climbing strategies. We hypothesized that metabolic cost would not differ between the 2 strategies, because the subjects would complete the 2 protocols with a similar speed that would minimize cost. Likewise, we hypothesized that muscle activity during stance would not differ between the 2 stepping strategies. Twelve subjects completed baseline and experimental protocols. For the baseline protocol, the subjects walked up a stairwell with a single-step and a double-step strategy. For the experimental protocol, each subject walked on a treadmill inclined to the same degree as the stairs at the speed and step frequency determined from the baseline protocol. Every subject completed the baseline testing with a faster average speed during the double-step protocol. After mimicking each strategy with our experimental methods, we calculated that the double-step strategy would yield a greater use of metabolic energy, equal to approximately 1.0-1.3 kcalxkg-1xh-1, on average 70-90 additional kcalxh-1. This double-step strategy required a greater activity for propulsion during stance for the ankle and knee extensors. In summary, to maximize metabolic cost and muscular activity, we recommend a double-stair-climbing (skip a step) strategy.
Background Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric surgery performed in North America. As our knowledge of the importance in limiting narcotic use in postoperative patients increases, we sought to evaluate the effect of transversus abdominis plane (TAP) blocks on inpatient narcotic use in patients undergoing LSG. Methods A retrospective review of LSG performed at a single institution by 3 bariatric surgeons was performed. All cases over a 15-month period were included, and anesthesia records were reviewed to stratify patients that received a TAP block and those that did not. Demographic, as well as surgical, outcomes were collected for all patients. Narcotic utilization, as reported in morphine equivalents (ME), was evaluated between the 2 groups. Results 384 LSG patients were identified, of which 37 (9.6%) received a TAP block. There was no statistically significant difference in postoperative morbidity, length of stay, or readmission between groups. Median narcotic utilization in hospital days 1 and 2 in patients with TAP blocks was 49 ME (Interquartile Range (IQR) 14.5-84.5) to 82.5 ME (IQR 57.4-106) in the no-TAP group ( P < .001). After controlling for multiple demographic- and patient-related cofactors, multiple linear regression analysis demonstrated TAP block patients utilized 22.48 ME less than the no-TAP group ( P < .001) in the first 2 days of their hospitalization. Discussion Patients that received a TAP block as a part of their perioperative anesthetic care utilized less in-hospital narcotics than those patients that did not receive a TAP block. TAP blocks should be considered as part of a multimodal pain control strategy for patients undergoing LSG.
Settings: Postoperative pain management is an ever-growing challenge with the rise of the opioid crisis. Ketamine is an NMDA channel blocker, considered an alternative to perioperative opioid use; small concentrations are safe. Objective: The primary objective of this study was to evaluate the impact of perioperative ketamine administration on postoperative opioid use and the length of hospital stay in bariatric patients.Methods: Four hundred (366) charts were retrospectively reviewed; of those, 187 received ketamine and were placed in the Ketamine group, 179 received standard-of-care pain management and were part of the No-Ketamine group. Data was collected using medical databases from July 2020 to January 2021.Results: A greater length of stay was recorded in the No-Ketamine group (45.67 ± 20.6 hours) when compared with the Ketamine group (40.6 ± 14.3 hours); P < 0.05. The Ketamine group had a mean MME of 17.5 ± 16.5 whereas the No-Ketamine had a mean MME of 22.3 ± 17.7, P < 0.05.Conclusions: Ketamine may be a feasible alternative to reduce opioid use and hospital length of stay. We believe that ketamine can be an important contribution to ERABS pathways, being responsible for improved outcomes after bariatric/metabolic surgical procedures.
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