NCT00851565.

Background and purposePostoperative pain is often severe after total knee arthroplasty (TKA). We investigated the efficacy of the local infiltration analgesia (LIA) technique, both intraoperatively and postoperatively.Methods48 patients undergoing TKA were randomized into 2 groups in a double-blind study. In group A, 400 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine were infiltrated periarticularly during operation. In group P, no injections were given. 21 h postoperatively, 200 mg ropivacaine, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly in group A, and the same volume of saline was injected in group P. All patients were followed up for 3 months.ResultsMedian morphine consumption was lower in group A during the first 48 h: 18 (1–74) mg vs. 87 (36–160) mg in group P. Postoperative pain was lower at rest in group A during the first 27 h, and on movement during the first 48 h, except at 21 h. Time to fulfillment of discharge criteria was shorter in group A than in group P: 3 (1–7) vs. 5 (2–8) days. Patient satisfaction was higher in group A than in group P on days 1 and 7. The unbound venous blood concentration of ropivacaine was below systemic toxic blood concentrations.InterpretationThe local infiltration analgesia (LIA) technique provides excellent pain relief and lower morphine consumption following TKA, resulting in shorter time to home readiness and higher patient satisfaction. There were few side effects and systemic LA concentrations were low.

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Summary Purpose:  Epilepsy causes a significant burden to patients and to society. We aimed to calculate the factual excess in direct and indirect costs associated with epilepsy. Methods:  Using records from the Danish National Patient Registry (1998–2006), we identified 64,587 Danish patients with a diagnosis of epilepsy. Using a ratio of one patient record to four control subject records, we identified 258,345 age‐ and gender‐matched randomly chosen citizens from the Danish Civil Registration System Statistics. Direct costs included frequencies and costs of hospitalizations and weighted outpatient use, according to diagnosis‐related group, and specific outpatient costs based on data from the Danish Ministry of Health. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits and hospitalizations and costs from primary sectors were based on data from the National Health Security. Indirect costs included labor supply–based income data, and all social transfer payments obtained from the Coherent Social Statistics. Key findings:  Patients with epilepsy had significantly higher rates of health‐related contacts and medication use and a higher socioeconomic cost, lower employment rates, and income compared with control subjects. These effects were identified up to 8 years before diagnosis, and worsened thereafter. The direct net annual health care and indirect costs were €14,575 for patients and €1,163 for controls, giving a consequent excess cost of €13,412. In addition, patients with epilepsy received an annual mean excess social transfer income of €4,194. Significance:  Epilepsy has major socioeconomic consequences for the individual patient and for society.

Background and purpose The degree of postoperative pain is usually moderate to severe following knee arthroplasty. We investigated the efficacy of local administration of analgesics into the operating area, both intraoperatively and postoperatively.Methods 40 patients undergoing unicompartmental knee arthroplasty (UKA) were randomized into 2 groups in a double–blind study (ClinicalTrials.gov identifier: NCT00653926). In group A (active), 200 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine (total volume 106 mL) were infiltrated intraoperatively into the soft tissue, while in group P (placebo), no injections were given. 21 hours postoperatively, 150 mg ropivacain, 30 mg ketorolac, and 0.1 mg epinephrine were injected intraarticularly via a catheter in group A, whereas patients in group P were injected with the same volume of saline (22 mL).Results Median hospital stay was shorter in group A than in group P: 1 (1–6) days as opposed to 3 (1–6) days (p < 0.001). Postoperative pain in group A was statistically significantly lower at rest after 6 h and 27 h and on movement after 6, 12, 22, and 27 h. Morphine consumption was statistically significantly lower in group A for the first 48 h, resulting in a lower frequency of nausea, pruritus, and sedation. Postoperatively, there were improved functional scores (Oxford knee score and EQ–5D) in both groups relative to the corresponding preoperative values.Interpretation Local injection of analgesics periarticularly at the end of the operation and intraarticularly at 21 h postoperatively provided excellent pain relief and earlier home discharge following UKA. There was a high degree of patient satisfaction in both groups after 6 months (Clinical Trials.gov: NCT 00653926).

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