Purpose: To compare unilateral and conventional bilateral bupivacaine spinal block in outpatients undergoing knee arthroscopy.Methods: One hundred healthy, premedicated patients randomly received conventional bilateral (n = 50) or unilateral (n = 50) spinal anesthesia with 8 mg hyperbaric bupivacaine 0.5%. A lateral decubitus position after spinal injection was maintained in unilateral group for 15 min. Times from spinal injection to readiness for surgery, block resolution, and home discharge were recorded.Results: Three patients in each group were excluded due to failed block. Readiness for surgery required 13 min (5 -25 min) with bilateral and 16 min (15 -30) with unilateral spinal block (P = 0.0005). Sensory and motor blocks on the operated limb were T 9 (T 12 -T 2 ) with a Bromage score 0/1/2/3: 0/2/0/45 in the unilateral group and T 7 (T 12 -T 1 ) with Bromage score 0/1/2/3: 4/1/6/36 with bilateral block (P = 0.026 and P= 0.016, respectively). Vasopressor was required only in five bilateral patients (P = 0.02). Two segment regression of sensory level and home discharge required 81 ± 25 min and 281 ± 83 min with bilateral block, and 99 ± 28 min and 264 ± 95 min with unilateral block (P = 0.002 and P = 0.90, respectively). Conclusion:Seeking unilateral distribution of spinal anesthesia provided more profound and longer lasting block in the operated limb, less cardiovascular effects, and similar home discharge compared with bilateral spinal anesthesia, with only a slight delay in preparation time.Objectif : Comparer le bloc rachidien unilatéral au bloc bilatéral traditionnel chez des patients ambulatoires qui subissent une arthroscopie du genou.Méthode : Cent patients sains ont reçu une prémédication et, de façon aléatoire, une rachianesthésie bilatérale traditionnelle (n = 50) ou unilatérale (n = 50) avec 8 mg de bupivacaïne hyperbare à 0,5 %. Après l'injection, les patients du groupe unilatéral ont été maintenus en décubitus latéral pendant 15 min. On a enregistré : le temps écoulé entre l'injection et le début de l'opération, le temps nécessaire à la résolution du bloc et le moment de la sortie du service.Résultats : Trois patients ont été exclus dans chaque groupe à cause de l'échec du bloc. Il a fallu 13 min (5 -25 min) de préparation à l'opération avec le bloc bilatéral et 16 min (15 -30) avec le bloc unilatéral (P = 0,0005). Les blocs sensitif et moteur sur le membre opéré ont été de T 9 (T 12 -T 2 ) avec des scores de 0/1/2/3: 0/2/0/45 à l'échelle de Bromage dans le groupe unilatéral et de T 7 (T 12 -T 1 ) et des scores de Bromage de 0/1/2/3: 4/1/6/36 avec le bloc bilatéral (P = 0,026 et P = 0,016, respectivement). Des vasopresseurs ont été nécessaires chez cinq patients seulement du groupe bilatéral (P = 0,02). Le temps nécessaire à la régression de deux segments du bloc sensitif et au congé a été de 81 ± 25 min et de 281 ± 83 min avec le bloc bilatéral, et de 99 ± 28 min et 264 ± 95 min avec le bloc unilatéral (P = 0,002 et P = 0,90, respectivement).Conclusion : La rachianesthésie unilatérale, compar...

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Using a prospective audit, we have evaluated the efficacy of an integrated autotransfusion regimen which comprised predepositing and intra- and postoperative blood salvage in major orthopaedic surgery. We examined prospectively the records of 1785 patients (1198 females, 5867 males, mean age 62 (range 16-90) yr, preoperative haemoglobin concentration 13.4 (SD 1.4) g dl-1) undergoing total hip arthroplasty (THA, 1229 patients), THA after removal of internal fixation devices (RFD + THA, 18 patients), total knee arthroplasty (TKA, 263 patients), revision surgery of the hip (HR cup + stem revision, 197 patients; cup revision, 53 patients; stem revision, 16 patients) and total knee revision (TKR, nine patients). We estimated that the number of predonations (MSBOS = maximum surgery blood order schedule) was 2 u. for THA, TKA and TKR, and 3 u. for partial or total hip revision and total hip arthroplasty with fixation removal. We found that it was possible to obtain the MSBOS in 1597 patients (89.5%). Homologous red blood cell (HRBC) transfusions were carried out in 131 patients (7.3%). We found that the need to use HRBC was significantly associated with failure to meet the number of MSBOS, female sex, lower preoperative haemoglobin concentration, use of calcium heparin for antithrombosis prophylaxis, more extensive surgery, higher ASA rating and co-existing diseases such as coronary artery disease.

This study analyzed the efficacy of venous thromboembolism prophylaxis in knee arthroscopy in 509 patients who received Parnaparin (Alfa Wassermann, Bologna, Italy), 3200 IU to 4250 IU daily, after minor arthroscopic knee surgery. No proximal deep venous thrombosis or other thromboembolic events occurred. Adverse events related to the treatment with Parnaparin were observed in 2 of 172 patients treated with 3200 IU/d and in 6 of 337 patients treated with 4250 IU/d, without any evidence of dose-proportionality in the incidence. Prophylaxis with a low-molecular-weight heparin such as Parnaparin should be considered in all patients who will be undergoing a procedure in which a tourniquet is used. If Parnaparin is used, it should be started immediately after knee arthroscopy at doses of 3200 to 4250 IU/d, according to the characteristics of the patients. Depending on the patient's risk factors, postoperative prophylaxis for 10 days may be appropriate.